A silicone breast implant consists of a flexible, solid silicone outer shell filled with cohesive silicone gel. A rupture, or leak, occurs when a tear forms in this shell, allowing the internal gel to escape. Ruptures are classified by migration distance. An intracapsular rupture means the gel remains contained within the fibrous scar tissue capsule that the body naturally forms around the implant. An extracapsular rupture occurs when the silicone gel breaches this capsule and spreads into the surrounding breast tissue.
Recognizing the Signs of a Rupture
The nature of a silicone rupture makes it difficult to detect without specialized imaging. Modern silicone gel is highly cohesive, often holding its shape even after the shell is compromised, leading to a “silent rupture.” Silent ruptures are intracapsular and typically cause no noticeable symptoms, often discovered incidentally during routine screening. The FDA recommends that individuals with silicone implants undergo an MRI scan for screening three years after the initial surgery and every two years thereafter.
A symptomatic rupture is often extracapsular and presents with noticeable physical changes. Patients may observe a gradual alteration in the breast’s shape, size, or contour, sometimes resulting in increased asymmetry. Other signs include a persistent increase in firmness, tenderness, or pain in the affected breast. These symptoms, such as a burning sensation or gradual hardening, result from the body’s inflammatory reaction to the free silicone.
Localized Effects of Silicone Migration
When silicone gel escapes the implant shell, a common consequence is an intensification of capsular contracture. This occurs when the surrounding scar tissue capsule thickens and tightens. This tightening can cause the breast to feel hard, distorted, and painful, as the body attempts to isolate the compromised implant and leaked gel.
Free silicone gel migrated into the breast tissue can trigger the formation of localized inflammatory masses called siliconomas or silicone granulomas. These firm nodules result from immune cells attempting to wall off the silicone particles. They can often be felt as palpable lumps within the breast tissue or sometimes under the skin.
In cases of extracapsular rupture, silicone can travel through the lymphatic system. This leads to the accumulation of gel particles in nearby lymph nodes, most commonly those in the armpit (axilla). This condition, known as silicone lymphadenopathy, can cause the lymph nodes to swell and become palpable.
Systemic Health Considerations
Some individuals with breast implants, including those with a confirmed rupture, report generalized symptoms known as Breast Implant Illness (BII). These symptoms can include chronic fatigue, joint and muscle pain, cognitive dysfunction (“brain fog”), anxiety, and skin issues. BII symptoms are reported with both saline and silicone implants, but many patients report intensification following a suspected or confirmed leak.
The relationship between silicone exposure and specific autoimmune or connective tissue disorders remains inconclusive in large-scale epidemiological studies. While some smaller studies suggest a potential association, the FDA and major medical bodies have not found a definitive causal link. Researchers are investigating BII origins to better understand the underlying mechanisms, which may involve a chronic inflammatory or immune response.
Silicone is an inert material, and many patients experience no systemic symptoms even with a ruptured implant. If systemic symptoms arise, consulting with specialists like rheumatologists is recommended to rule out other causes. BII symptoms are often reported to improve or resolve entirely following the removal of the implants, especially when removal occurs within a decade of implantation.
Treatment and Removal Procedures
Once a silicone implant rupture is confirmed, medical specialists recommend its removal, even if the patient is asymptomatic. This recommendation is based on the long-term risk of complications, such as further silicone migration, persistent inflammation, and progression of capsular contracture. Prompt removal is particularly important for extracapsular ruptures, where the silicone has spread beyond the capsule.
The surgical procedure involves explantation, which is the removal of the compromised implant. For ruptured silicone implants, this is almost always accompanied by a total capsulectomy, meaning the complete removal of the surrounding scar tissue capsule. Removing the capsule is necessary because leaked silicone gel often infiltrates the fibrous tissue.
If the rupture is extracapsular, the surgeon must meticulously remove all visible free silicone and any siliconomas from the surrounding breast tissue. After removal, the patient can replace the implant with a new one (saline or silicone) or choose a different reconstruction, such as fat grafting. For many individuals experiencing systemic symptoms, surgical removal of the implant and capsule often leads to a reduction in generalized symptoms.